Alcohol Addiction in War Veterans Treated in a In-patient Psychiatric Facility: Incidence, Comorbidity with PTSD Symptoms, Association with Combat Stressors

Abstract

BACKGROUND: The dearth of and inconsistency in the data on the prevalence, risks of occurrence, comorbidity, and causation of stress-related disorders and alcohol use disorders in Russian veterans of local wars constituted the background for this study.

AIM: To study the psychopathological structure, clinical changes, and the reasons for the mental disorders suffered by Russian veterans of local wars; in particular, to study the prevalence, pathogenic factors, comorbidity of alcohol addiction and alcohol abuse, together with symptoms of stress disorders, in Russian veterans undergoing inpatient treatment.

METHODS: Our observational case-control study included 685 patients who were undergoing treatment in the psychiatric department of a military hospital: the Main group (veterans) consisted of 264 veterans of armed conflicts who had undergone inpatient treatment from 1992 to 2010; the Control group, 1, 296 patients, all servicemen and military pensioners who had undergone inpatient treatment during a calendar year and had never taken part in combat operations in the past; Control group 2, 125 military personnel (regular and reserve) who had not taken part in combat operations and corresponded to the patients of the main group in terms of the mean age and age distribution curve. We performed a clinical and psychopathological analysis of the symptoms identified in patients from the compared samples and, then, compared them with the ICD-10 criteria of post-traumatic stress disorder (PTSD) and alcohol-related disorders. This allowed us to establish the significance of the difference in their frequency and degree of association at the stage of the data analysis.

RESULTS: We uncovered no difference in the prevalence of symptoms of alcohol addiction and alcohol abuse among veterans and other servicemen and military pensioners who had not taken part in combat operations. However, there was a tendency to underdiagnose alcohol addiction in veterans in general and those with symptoms of PTSD, in particular. That is, alcohol addiction was not diagnosed in most cases when the veterans displayed symptoms of stress or other mental disorders, in addition to the signs of alcohol addiction. In most such cases, a stress-related mental disorder or another mental disorder with identified signs was diagnosed and alcohol abuse was described as a concomitant disorder or a complication. There was no significant association between any form of alcohol addiction or abuse and the presence of stress disorder symptoms in our sample of veterans; on the contrary, symptoms of re-experience of trauma were more often observed in veterans who were not prone to frequent drinking. The incidence of combat stressors traced in the medical history did not differ in veterans with any form of alcohol abuse and veterans who were not prone to frequent drinking. However, the main group subjects with alcohol addiction more often displayed cases of addictive behavior during combat operations. Therefore, alcohol abuse during combat operations requires additional research to better establish its prognostic significance.

CONCLUSION: This Study found no difference in the incidence of alcohol dependence and alcohol abuse among veterans and other officers. In the sample of veterans, there was no significant association between alcoholism and the presence of PTSD symptoms or a history of combat stressors. It is possible that the same risk of alcohol addiction in different categories of military officers is due to a compact of social stressors that equally had a more significant adverse effect on the entire population of Russian military personnel in the 90s of the last century and the first years of this century, as well as the massive abuse of alcohol, which could also equalize the risks of developing alcohol dependence in all groups of militaries.

Keywords

alcohol addiction / alcoholism / alcohol abuse / combat mental trauma / combat stress disorder / post-traumatic stress disorder / combat stress

References

[1] Litvintsev SV, Snedkov EV, Reznik AM. Combat mental trauma: A guide for doctors. Moscow: Meditsina; 2005. (In Russ).

[2] Snedkov EV, Litvintsev SV, Reznik AM, Truschelev SA. Combat stress reactions: A textbook for the system of postgraduate professional education of doctors. Moscow: Medkniga; 2007. (In Russ).

[3] Sofronov AG. Is it possible to prevent drug addiction among veterans of local wars? In: Yu.L. Shevchenko, editor. Topical issues of military and environmental psychiatry: Textbook. Saint Petersburg; 1995. (In Russ).

[4] Maria-Rios CE, Morrow JD. Mechanisms of shared vulnerability to post-traumatic stress disorder and substance use disorders. Front Behav Neurosci. 2020;14:6. doi: 10.3389/fnbeh.2020.00006

[5] Straus E, Haller M, Lyons RC, Norman SB. Functional and psychiatric correlates of comorbid post-traumatic stress disorder and alcohol use disorder. Alcohol Res. 2018;39(2):121–129.

[6] Dworkin ER, Bergman HE, Walton TO, Walker DD, Kaysen DL. Co-Occurring post-traumatic stress disorder and alcohol use disorder in U.S. military and veteran populations. Alcohol Res. 2018;39(2):161–169.

[7] Rothberg JM, Koshes RJ, Shanahan J, Christman K. Desert shield deployment and social problems on a U.S. army combat support post. Mil Med. 1994;159(3):246–248.

[8] Sutker PB, Uddo M, Brailey K, Allain AN, Errera P. Psychological symptoms and psychiatric diagnoses in Operation Desert Storm troops serving Graves registration duty. J Trauma Stress. 1994;7(2):159–171. doi: 10.1007/BF02102942

[9] Milliken CS, Auchterlonie JL, Hoge CW. Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA. 2007;298(18):2141–2148. doi: 10.1001/jama.298.18.2141

[10] Baker DG, Heppner P, Afari N, et al. Trauma exposure, branch of service, and physical injury in relation to mental health among U.S. veterans returning from Iraq and Afghanistan. Mil Med. 2009;174(8):773–778.

[11] Keane TM, Gerardi RJ, Lyons JA, Wolfe J. The interrelationship of substance abuse and posttraumatic stress disorder. Epidemiological and clinical considerations. Recent Dev Alcohol. 1988;6:27–48. doi: 10.1007/978-1-4615-7718-8_2

[12] Seal KH, Cohen G, Waldrop A, Cohen BE, Maguen S, Ren L. Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001–2010: Implications for screening, diagnosis and treatment. Drug Alcohol Depend. 2011;116(1–3):93–101. doi: 10.1016/j.drugalcdep.2010.11.027

[13] Feinstein A, Owen J, Blair N. A hazardous profession: war, journalists, and psychopathology. Am J Psychiatry. 2002;159(9):1570–1575. doi: 10.1176/appi.ajp.159.9.1570

[14] Jakupcak M, Tull MT, McDermott MJ, Kaysen D, Hunt S, Simpson T. PTSD symptom clusters in relationship to alcohol misuse among Iraq and Afghanistan war veterans seeking post-deployment VA health care. Addict Behav. 2010;35(9):840–843. doi: 10.1016/j.addbeh.2010.03.023

[15] Blanco C, Xu Y, Brady K, Perez-Fuentes G, Okuda M, Wang S. Comorbidity of posttraumatic stress disorder with alcohol dependence among US adults: results from national epidemiological survey on alcohol and related conditions. Drug Alcohol Depend. 2013;132(3):630–638. doi: 10.1016/j.drugalcdep.2013.04.016

[16] Kulka RA, Schlenger WE, Fairbank JA, et al. Trauma and the Vietnam war generation. Report of findings from the National Vietnam Veterans Readjustment Study. 1st edition. New York: Brunner Mazel Publishers; 1990.

[17] Smith SM, Goldstein RB, Grant BF. The association between post-traumatic stress disorder and lifetime DSM-5 psychiatric disorders among veterans: Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). J Psychiatr Res. 2016;82:16–22. doi: 10.1016/j.jpsychires.2016.06.022

[18] Wisco BE, Marx BP, Wolf EJ, Miller MW, Southwick SM, Pietrzak RH. Posttraumatic stress disorder in the US veteran population: results from the National Health and Resilience in Veterans Study. J Clin Psychiatry. 2014;75(12):1338–1346. doi: 10.4088/JCP.14m09328

[19] Cottler LB, Compton WM, Mager D, Spitznagel EL, Janca A. Posttraumatic stress disorder among substance users from the general population. Am J Psychiatry. 1992;149(5):664–670. doi: 10.1176/ajp.149.5.664

[20] Bremner JD, Southwick SM, Darnell A, Charney DS. Chronic PTSD in Vietnam combat veterans: course of illness and substance abuse. Am J Psychiatry. 1996;153(3):369–375. doi: 10.1176/ajp.153.3.369

[21] Perkonigg A, Kessler RC, Storz S, Wittchen HU. Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatr Scand. 2000;101(1):46–59. doi: 10.1034/j.1600-0447.2000.101001046.x

[22] Freeman T, Kimbrell T. Relationship of alcohol craving to symptoms of posttraumatic stress disorder in combat veterans. J Nerv Ment Dis. 2004;192(5):389–390. doi: 10.1097/01.nmd.0000126735.46296.a4

[23] Norman SB, Tate SR, Anderson KG, Brown SA. Do trauma history and PTSD symptoms influence addiction relapse context? Drug Alcohol Depend. 2007;90(1):89–96. doi: 10.1016/j.drugalcdep.2007.03.002

[24] Scherrer JF, Xian H, Lyons MJ, et al. Posttraumatic stress disorder; combat exposure; and nicotine dependence, alcohol dependence, and major depression in male twins. Compr Psychiatry. 2008;49(3):297–304. doi: 10.1016/j.comppsych.2007.11.001

[25] Tate SR, Norman SB, McQuaid JR, Brown SA. Health problems of substance-dependent veterans with and those without trauma history. J Subst Abuse Treat. 2007;33(1):25–32. doi: 10.1016/j.jsat.2006.11.006

[26] Shipherd JC, Stafford J, Tanner LR. Predicting alcohol and drug abuse in Persian Gulf War veterans: what role do PTSD symptoms play? Addict Behav. 2005;30(3):595–599. doi: 10.1016/j.addbeh.2004.07.004

[27] Kitaev-Smyk LA. The physiology of stress. Moscow: Nauka; 1983. (In Russ).

[28] Davidson PB. Vietnam at war: the history (1946–1975). Novato, Calif: Presidio Press; 1988.

[29] Jacobson IG, Ryan MA, Hooper TI, et al. Alcohol use and alcohol-related problems before and after military combat deployment. JAMA. 2008;300(6):663–675. doi: 10.1001/jama.300.6.663

[30] Miller MW, Fogler JM, Wolf EJ, Kaloupek DG, Keane TM. The internalizing and externalizing structure of psychiatric comorbidity in combat veterans. J Trauma Stress. 2008;21(1):58–65. doi: 10.1002/jts.20303

[31] Ullman SE, Relyea M, Peter-Hagene L, Vasquez AL. Trauma histories, substance use coping, PTSD, and problem substance use among sexual assault victims. Addict Behav. 2013;38(6):2219–2223. doi: 10.1016/j.addbeh.2013.01.027

[32] McDevitt-Murphy ME, Fields JA, Monahan CJ, Bracken KL. Drinking motives among heavy-drinking veterans with and without posttraumatic stress disorder. Addict Res Theory. 2015;23(2):148–155. doi: 10.3109/16066359.2014.949696

[33] Ouimette PC, Moos RH, Finney JW. Two-year mental health service use and course of remission in patients with substance use and posttraumatic stress disorders. J Stud Alcohol. 2000;61(2):247–253. doi: 10.15288/jsa.2000.61.247

[34] Kaysen D, Atkins DC, Moore SA, Lindgren KP, Dillworth T, Simpson T. Alcohol use, problems, and the course of posttraumatic stress disorder: A prospective study of female crime victims. J Dual Diagn. 2011;7(4):262–279. doi: 10.1080/15504263.2011.620449

[35] Zoricic Z, Karlovic D, Buljan D, Marusic S. Comorbid alcohol addiction increases aggression level in soldiers with combat-related post-traumatic stress disorder. Nord J Psychiatry. 2003;57(3):199–202. doi: 10.1080/08039480310001337

[36] Stappenbeck CA, Hellmuth JC, Simpson T, Jakupcak M. The effects of alcohol problems, PTSD, and combat exposure on nonphysical and physical aggression among Iraq and Afghanistan war veterans. Psychol Trauma. 2014;6(1):65–72. doi: 10.1037/a0031468

[37] Elbogen EB, Johnson SC, Wagner HR, Sullivan C, Taft CT, Beckham JC. Violent behaviour and post-traumatic stress disorder in US Iraq and Afghanistan veterans. Br J Psychiatry. 2014;204(5):368–375. doi: 10.1192/bjp.bp.113.134627

[38] Mellman TA, Randolph CA, Brawman-Mintzer O, Flores LP, Milanes FJ. Phenomenology and course of psychiatric disorders associated with combat-related posttraumatic stress disorder. Am J Psychiatry. 1992;149(11):1568–1574. doi: 10.1176/ajp.149.11.1568

RIGHTS & PERMISSIONS

Reznik A.M., Syunyakov T.S., Arbuzov A.L.